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Furnas D.W.,University of Florida | Edmonds L.A.,University of Florida | Edmonds L.A.,Brain Rehabilitation and Research Center
Aphasiology | Year: 2014

Background: A number of computerised treatments have been developed for aphasia, but few have remediated typing, an important functional task, and/or been implemented over the Internet via teletherapy, which can increase access to therapeutic services. The current study created a computerised version of Verb Network Strengthening Treatment (VNeST) and administered it via telerehabilitation over the Internet. VNeST is a semantic treatment which seeks to improve lexical retrieval of words through the conceptual connection between verbs and thematic roles. Previous iterations of VNeST have shown improvement in both spoken and written lexical retrieval for people with moderate and moderate-to-severe aphasia.Aims: This study investigates changes to lexical retrieval with four hierarchical outcome measures. The research questions were: Does treatment using Computerised VNeST (VNeST-C) result in pre- to post-treatment increases in: (1) spoken and typed lexical retrieval of trained (e.g., The farmer is weighing the apples.) and untrained words (e.g., The carpenter is measuring the lumber.) in a picture description task, (2) untreated single-word naming accuracy of nouns and verbs in spoken and typed modalities, (3) spoken and typed lexical retrieval as measured by informative words, efficiency of production and complete utterances within discourse, and (4) standardised measures of cognitive and language abilities?Methods & Procedures: Two people with aphasia were treated three times per week for 8 weeks using the VNeST-C program. A single-subject experimental design was used to evaluate changes in trained and untrained stimuli and tasks. Additional pre-treatment and post-treatment testing was also conducted.Outcomes & Results: Results indicate improvements on lexical retrieval during sentence production of trained and untrained stimuli. Additional improvement was observed for single-word naming of untrained nouns and verbs in spoken and typed modalities and standardised measures of aphasia and writing-by-hand. Limited generalisation to discourse was also observed, including a general increase in word output and decrease in typed neologisms.Conclusions: The results of this study suggest that the VNeST-C program and protocol have promise as a broadly generalising treatment for people with aphasia. With refinement of duration and intensity of the protocol, it may be a viable option for treating aphasia. © 2014 Taylor & Francis.

Reier P.J.,Florida College | Lane M.A.,Florida College | Hall E.D.,University of Kentucky | Teng Y.D.,Harvard University | And 2 more authors.
Handbook of Clinical Neurology | Year: 2012

Advances in the neurobiology of spinal cord injury (SCI) have prompted increasing attention to opportunities for moving experimental strategies towards clinical applications. Preclinical studies are the centerpiece of the translational process. A major challenge is to establish strategies for achieving optimal translational progression while minimizing potential repetition of previous disappointments associated with clinical trials. This chapter reviews and expands upon views pertaining to preclinical design reported in recently published opinion surveys. Subsequent discussion addresses other preclinical considerations more specifically related to current and potentially imminent cellular and pharmacological approaches to acute/subacute and chronic SCI. Lastly, a retrospective and prospective analysis examines how guidelines currently under discussion relate to select examples of past, current, and future clinical translations. Although achieving definition of the " perfect" preclinical scenario is difficult to envision, this review identifies therapeutic robustness and independent replication of promising experimental findings as absolutely critical prerequisites for clinical translation. Unfortunately, neither has been fully embraced thus far. Accordingly, this review challenges the notion " everything works in animals and nothing in humans" , since more rigor must first be incorporated into the bench-to-bedside translational process by all concerned, whether in academia, clinical medicine, or corporate circles. © 2012 Elsevier B.V.

Kendall D.,University of Washington | Kendall D.,Brain Rehabilitation and Research Center | Raymer A.,Brain Rehabilitation and Research Center | Raymer A.,Old Dominion University | And 6 more authors.
Journal of Rehabilitation Research and Development | Year: 2014

The purpose of this study was to create a "behavioral treatment engine" for future use in research on physiological adjuvants in aphasia rehabilitation. We chose the behavioral target anomia, which is a feature displayed by many persons who have aphasia. Further, we wished to saturate the treatment approach with many strategies and cues that have been empirically reported to have a positive influence on aphasia outcome, with the goal being to optimize the potential for positive response in most participants. A single-subject multiple baseline design with replication across eight participants was employed. Four men and four women, with an average age of 62 yr and an average of 63.13 mo poststroke onset, served as participants. Word-retrieval treatment was administered 3 d/wk, 1 h/d for a total of 20 treatment hours (6-7 wk). Positive acquisition effects were evident in all eight participants (d effect size [ES] = 5.40). Treatment effects were maintained 3 mo after treatment termination for five participants (d ES = 2.94). Within and across semantic category, generalization was minimal (d ES = 0.43 within and 1.09 across). This study demonstrates that this behavioral treatment engine provides a solid platform on which to base future studies whereby various treatment conditions are manipulated and pharmacologic support is added.

Edmonds L.A.,Brain Rehabilitation and Research Center | Edmonds L.A.,University of Florida | Mammino K.,Brain Rehabilitation and Research Center | Ojeda J.,Brain Rehabilitation and Research Center | Ojeda J.,University of Florida
American Journal of Speech-Language Pathology | Year: 2014

Purpose: Verb Network Strengthening Treatment (VNeST) is an aphasia treatment that targets verbs (e.g., measure) and their related thematic roles (e.g., carpenter-lumber). Previous studies reported encouraging results in a number of participants using single-subject design with improvements observed on naming, sentence production, and discourse. The purpose of the current study was to conduct a group analysis evaluating the effect of VNeST on similar outcomes. Method: A multiple baseline design across participants was conducted with 11 persons with aphasia due to stroke. Wilcoxon signed-ranks tests were used to evaluate potential improvement from pre- to posttreatment and maintenance. Individual effect sizes were also calculated to evaluate magnitude of change within and across participants. Results: Results showed significant improvement at posttreatment and maintenance on trained and untrained sentence probes and object and action naming. Improvement in the production of sentences not targeted in treatment was nonsignificant at posttreatment assessment but significant at maintenance. Moderate increases in percentage of complete utterances and overall informativeness were observed on discourse. Conclusion: The results of this study replicate previous findings and provide evidence that VNeST may promote specific and generalized lexical retrieval abilities and affect basic syntax production in both constrained and discourse production tasks. © American Speech-Language-Hearing Association.

Doperalski A.E.,Brain Rehabilitation and Research Center | Doperalski A.E.,University of Florida | Tester N.J.,Brain Rehabilitation and Research Center | Tester N.J.,University of Florida | And 4 more authors.
Journal of Neurotrauma | Year: 2011

Following a lateralized spinal cord injury (SCI) in humans, substantial walking recovery occurs; however, deficits persist in adaptive features of locomotion critical for community ambulation, including obstacle negotiation. Normal obstacle negotiation is accomplished by an increase in flexion during swing. If an object is unanticipated or supraspinal input is absent, obstacle negotiation may involve the spinally organized stumbling corrective response. How these voluntary and reflex components are affected following partial SCI is not well studied. This study is the first to characterize recovery of obstacle negotiation following low-thoracic spinal hemisection in the cat. Cats were trained pre- and post-injury to cross a runway with an obstacle. Assessments focused on the hindlimb ipsilateral to the lesion. Pre-injury, cats efficiently cleared an obstacle by increasing knee flexion during swing. Post-injury, obstacle clearance permanently changed. At 2 weeks, when basic overground walking ability been recovered, the hindlimb was dragged over the obstacle (∼90%). Surprisingly, the stumbling corrective response was not elicited until after 2 weeks. Despite a notable increase, between 4 and 8 weeks, in the ability to modify limb trajectory when approaching an obstacle, limb lift during obstacle approach was insufficient during ∼50% of encounters and continued to evoke the stumbling corrective response even at 16 weeks. A post-injury lead limb bias identified during negotiations with complete clearance, suggests a potential training strategy to increase the number of successful clearances. Therefore, following complete severing of half of the spinal cord, the ability to modify ipsilateral hindlimb trajectory shows significant recovery and by 16 weeks permits effective clearing of an obstacle, without contact, ∼50% of the time. Although this suggests plasticity of supporting circuitry, it is insufficient to support consistent clearance. This inconsistency, even at the most chronic time point assessed (16 weeks), is probably a contributing factor to falls reported for people with SCI. © Copyright 2011, Mary Ann Liebert, Inc.

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